Need for an informed alcohol choice & an informed alcohol policy in India

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Enjoying a couple drinks is not synonymous with the risky behavior of binge drinking. Nonetheless, binge drinking is a rising trend on college campuses, hostels, and amongst the neo-rich and illiterate sections in India. Given that healthy alcohol consumption and alcohol abuse are both rapidly increasing, especially with a burgeoning middle class, we need to tackle the good, the bad and the ugly of alcohol head on before it gets out of control.

In the last few years, there has been a dramatic rise in rehabilitation clinics and NGOs mostly professing prohibition. Many NGOs are asking for prohibition, increased taxation, retaining bans on alcohol products, and limiting sale outlets. Regardless of the intentions, it is obvious that their efforts have been at best ineffective and in most cases counterproductive. In addition, many genuine grass root movements of concerned citizens, especially the mothers and wives of addicts, have resulted in gaining sufficient momentum for a ban on alcohol to become a state and central election issue. Prohibition by late populist chief minister N. T. Rama Rao in Andhra Pradesh was a result of such a grass root movement founded in the socio-economic costs of alcohol abuse in the agricultural sector.

The prohibition in Andhra however, was rather short-lived and an utter failure, much like the current bans in Gujarat and Mizoram. Banning the regulated sale of safe alcohol has resulted in people consuming hazardous alcohol of shoddy quality, binging in secrecy, and driving far distances to consume alcohol, which results in increased alcohol related traffic incidences. The bans have also meant the loss of much needed revenues for a growing India that regulated alcohol sales generate. This counterproductive nature of prohibition is a global trend and the American prohibition era and Pakistan’s prohibition from the Zia era onwards are good case studies for anyone wanting to evaluate the merits and demerits of going dry.

Unfortunately, due to a lack of data acquisition, reporting, and monitoring by federal and state agencies, there is very little large scale data available on drinking patterns in India. This deficiency of empirical evidence is debilitating for effective policy changes, but it is not the only bottleneck preventing a mature national debate on alcohol consumption. The main blockade is the immature political agenda that amounts to an unproductive and pretentious debate siding alcohol vs. no alcohol, as if alcohol is only bad and not a part of our long rich culture, heritage, and a potential source of health and economic benefits. The hundreds of deaths in Orissa and Gujarat due to illicit liquor should have been a wakeup call for the need to change this inflexible and infantile alcohol debate.

Despite the glaring failure of prohibition, not just the government is to blame. Many anti-alcohol organizations have been unrelenting in their demands for prohibitory rules rather than encouraging healthy alcohol policies and education. Just like forcing abstinence is no way to solve the problem of sexually transmitted diseases, prohibiting alcohol is no way to cure the evils of alcohol addiction and binging. It is unlikely to expect that recently unveiled increases in the health budget and more donations to prohibitionist NGOs are going to fix the problem of alcohol abuse. Sales of alcohol, whether legal or illegal, will continue as they have in the past. What can make a difference though, is the spread of information on alcohol abuse. In a democracy, the buck really stops with the private citizen; hence this piece is intended as food for thought for drinkers and potential drinkers so they can make their own informed choices.

It is claimed by some federal reports that the epidemic of binge drinking can account up to 45% of total consumption in the US. Activists organizations against regulations put the numbers much lower, but still at shocking levels. The data for India is limited, but the trend is towards steep increases in binge drinking, as is the case in other economies where alcohol is a forbidden fruit – a societal taboo. Binge drinking has various definitions, but in general, consists of rapidly raising a person’s blood alcohol concentration. This usually takes around 5 drinks for males and 4 for females in a span of approximately 2 hours.

Binge drinking, especially as a repeat pattern, is associated with many health problems including alcohol poisoning, liver sclerosis, cardiovascular diseases, sexual dysfunction, and fetal alcohol syndrome. In addition, according to the Center for Disease Control and Prevention (CDC) of the USA, binge drinkers are over 10 times more likely to report driving under the influence of alcohol compared to non-binge drinkers. The World Health Organization (WHO) estimates that 2.5 million deaths per year worldwide are caused by alcohol related incidents including drunk driving. A strong correlation also exists between alcohol and crime, though one can debate if alcohol actually causes crime or merely acts as a societal permission slip for perpetrators to commit preconceived crimes, as suggested by some placebo alcohol studies. Given the infestation of many cities with rapists and muggers, especially the National capital territory, accepting any drink from a stranger or binging in the presence of strangers should be a big no no.

We may sound like we are using hypocritical scare tactics while criticizing prohibition, but hold on; we are not done talking about the benefits of responsible drinking. Being neuroscientists interested in addiction, we cannot deny coming across a plethora of literature on the many health benefits of moderate drinking. Moderate drinking is no more than 2 drinks for women and no more than 3 to 4 drinks for men in a day, preferably well spaced with snacks or meals to slow ethanol absorption. Moderate amounts of alcohol have been correlated with reducing dementia and Alzheimer’s disease, improving cardiac functioning, and reducing stroke incidences, type 2 diabetes, osteoporosis, gallbladder diseases, arthritis, renal cell carcinoma, thyroid cancer, and non-Hodgkin lymphoma.

These advantages of moderate alcohol consumption are not limited to red wine that, in part, derives benefits from other ingredients. Ethanol in any form, as long as it is consumed in moderation, confers the above mentioned health benefits. If one chooses to drink alcohol, then he or she should think about making it a social thing, to be enjoyed slowly and responsibly, maybe while thinking of the Nazms of Shayre Aazam Mirza Ghalib or of Madhushala by Hariwansh Rai Bachchan or humming the latest release of Shakira in some newly opened pub in Cannaught Place (sorry, Rajiv Chowk makes no sense). Make the time of sharaab a time for suroor and not a time for blackout and hangovers. Make it a social lubricant and not a societal burden.

While abstinence taught by Vaishnav traditions of Hinduism, Islam, Sikhism, and Jainism has its place, so do the Vedic hymns, Shaivism, Buddhism, Tantra, streams of Catholicism, and many indigenous animist and tribal traditions that celebrate alcohol in moderation. Though it is poorly recognized in the West, a place where distillation only started in the Middle Ages, India is a land that has long enjoyed all kinds of alcoholic beverages. Whether looking back at our knowledge of ancient India or at a recent admixture of Portuguese and Indian traditions in the form of the cashew drink of Fenny, alcohol is food in moderation and poison in excess. When we think of the absolute abstinence of Mahatma, let us also think of the enjoyment of Mahua – the liquor made from flowers, which has played a central role in the lives of indigenous people from ancient times. If you are of religious bent and enjoy alcohol, then maybe the “madhyam marga” taught by Budhism and Bhagvata Gita will guide your alcohol choice.

If you worship at the altars of science and look at religion from cultural perspective, like us, then we hope that the overwhelming data on the dangers of excess will sway you to the path of moderation. Alcohol should not be thought of as a forbidden fruit, as cultural taboos in contemporary India have made it out to be. It should not be a vehicle for teenage rebellion or an exit route from the rural life of a broken village and its traditions. Multiple studies on college drinking in the USA, Australia, and UK have shown that people overestimate how much their peers are drinking and hence binge due to peer pressure. Across multiple studies, the strategy of publishing college drinking habits actually has been shown to encourage more responsible drinking habits. Alcohol is not really that special on its own. It is only as special as the person enjoying it and the company that makes pleasant moments, lifelong memories and friendships.

We hope this time around, those who do not know when to stop, celebrate festivals with non-alcoholic beverages and those who want to enjoy alcohol enjoy the colors with family and friends with a gentle suroor and not drunken revelry.

Written by,

Dr. Sukant Khurana is a New York based scientist, artist and writer of Indian origin. His basic research involves neurophysiology, computational neuroscience, sensory perception, addiction, learning and memory, while his applied research extends into many areas of drug discovery and problems of the developing world. Both his visual art and writing explore the issues of modernization, health, displacement and identity.

Dr. Brook Robinson

Dr. Brooks Robinson got his Ph.D. in neuroscience from the University of Texas, Austin. He is currently researching opioid addiction at Oregon Health Science University.